Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056002706 | IL |
NPI | 1003161977 |
---|---|
Provider Name | Ms. Sara Simpson |
First Address | Romeoville, IL 60446-6507 |
Second Address | Romeoville, IL 60446-6507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 23/10/2012 |